基线患者特征通常在手术前被捕获，但不能准确预测接受腰椎微切除术后物理治疗的长期结果。
Baseline Patient Characteristics Commonly Captured Before Surgery Do Not Accurately Predict Long-Term Outcomes of Lumbar Microdiscectomy Followed by Physiotherapy.
机构信息
Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
Department of Neurosurgery and Research, Kliniek ViaSana, Mill, The Netherlands.
出版信息
Spine (Phila Pa 1976). 2020 Jul 15;45(14):E885-E891. doi: 10.1097/BRS.0000000000003448.
STUDY DESIGN
Prospective cohort study.
OBJECTIVE
To develop and internally validate prognostic models based on commonly collected preoperative data for good and poor outcomes of lumbar microdiscectomy followed by physiotherapy.
SUMMARY OF BACKGROUND DATA
Lumbar microdiscectomy followed by physiotherapy is a common intervention for lumbar radiculopathy. Postoperatively, a considerable percentage of people continues to experience pain and disability. Prognostic models for recovery are scarce.
METHODS
We included 298 patients with lumbar radiculopathy who underwent microdiscectomy followed by physiotherapy. Primary outcomes were recovery and secondary outcomes were pain and disability at 12 months follow-up. Potential prognostic factors were selected from sociodemographic and biomedical data commonly captured preoperatively. The association between baseline characteristics and outcomes was evaluated using multivariable logistic regression analyses.
RESULTS
At 12 months follow-up, 75.8% of the participants met the criterion for recovery. Variables in the model for good recovery included: younger age, leg pain greater than back pain, high level of disability, and a disc herniation at another level than L3-L4. The model for poor recovery included: lower educational level, prior back surgery, and disc herniation at L3-L4. Following internal validation, the explained variance (Nagelkerke R) and area under the curve for both models were poor (≤0.02 and ≤0.60, respectively). The discriminative ability of the models for disability and pain were also poor.
CONCLUSION
The outcome of microdiscectomy followed by postoperative physiotherapy cannot be predicted accurately by commonly captured preoperative sociodemographic and biomedical factors. The potential value of other biomedical, personal, and external factors should be further investigated.
LEVEL OF EVIDENCE
研究设计
前瞻性队列研究。
目的
基于通常收集的术前数据，开发并内部验证腰椎显微减压术后行物理治疗的良好和不良结局的预后模型。
背景数据摘要
腰椎显微减压术后行物理治疗是治疗腰椎神经根病的常见方法。术后，相当一部分人仍会出现疼痛和残疾。缺乏恢复的预后模型。
方法
我们纳入了 298 例接受腰椎显微减压术后行物理治疗的腰椎神经根病患者。主要结局是恢复，次要结局是 12 个月随访时的疼痛和残疾。从术前通常收集的社会人口学和生物医学数据中选择潜在的预后因素。使用多变量逻辑回归分析评估基线特征与结局之间的关系。
结果
在 12 个月的随访中，75.8%的参与者符合恢复标准。良好恢复模型中的变量包括：年龄较小、腿痛重于背痛、较高的残疾程度以及与 L3-L4 水平不同的椎间盘突出。不良恢复模型的变量包括：较低的教育水平、既往背部手术和 L3-L4 椎间盘突出。经过内部验证，两个模型的解释方差（Nagelkerke R）和曲线下面积均较差（分别为≤0.02 和≤0.60）。这些模型对残疾和疼痛的判别能力也较差。
结论
术后行物理治疗的显微减压术的结果不能通过术前通常收集的社会人口学和生物医学因素准确预测。其他生物医学、个人和外部因素的潜在价值应进一步研究。
证据水平
3 级。
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